People who have experienced sexual assault or trauma

Find information and resources on how to engage patients who have experienced sexual assault or trauma.

Resources

For patients

You can provide these resources to patients, to help them before, during and post screening. See the full resource library.

    Before screening appointment

    During screening appointment

    Post screening appointment

    For healthcare providers

    Sexual assault and cervical screening – resource card – discusses the impact of sexual assault on cervical screening and provides suggestions for supporting victims/survivors.

    Considerations

    Sexual assault is common in Australia, with 19% of women having experienced some form of sexual violence since the age of 15.

    Sexual assault includes any unwanted sexual act or behaviour that

    • is threatening, violent, forced or coercive
    • a person has not given consent or was not able to give consent.

    People who have experienced sexual assault are often reminded of the experience by gynaecological procedures and are less likely to attend for cervical screening. If they do screen, they are more likely to have a negative experience during the procedure. They are also more likely to have higher levels of gynaecological problems and cervical neoplasia.

    Barriers

    • Feelings of anxiety, shame, embarrassment, fear and vulnerability
    • Avoidance as a way to cope with trauma (i.e. avoiding a gynaecological examination as a way to control or avoid triggers of trauma response)
    • Reluctance to disclose sexual assault to a healthcare provider
    • Parallels with the abuse situation/reminder of the sexual assault – for example, perceived loss of control, the power disparity between healthcare providers and patients, feeling exposed and the physical sensation of the examination
    • The gynaecological procedure may feel threatening and re-traumatising
    • Lack of trust, feeling unsafe
    • Lack of availability of a female doctor or nurse
    • Physical pain or discomfort during examination
    • Healthcare providers’ lack of knowledge about the impact of sexual assault
    • Insensitivity of healthcare providers

    Strategies to engage

    Strategy

    Details

    Staff training

    Encourage all healthcare providers to undertake training about sexual assault, supporting patients to participate in cervical screening, managing disclosure and making referrals to specially trained cervical screening providers. This training should build knowledge and skills to feel more confident to meet the needs of women.

    Appropriate communication

    • Present opportunities for disclosure of sexual assault (e.g. including questions during history taking).
    • Offer more than one appointment and/or longer appointment times (e.g. the first visit to familiarise the patient with healthcare providers, procedure and instruments and the second for the test itself). This strategy will also help build rapport and trust.
    • Provide clear information about the screening options available, including self-collection or clinician-collection.
    • If clinician-collection is chosen the below points may be helpful:
      • Ask the patient for their consent before undertaking the test.
      • Acknowledge the difficulties that screening poses for these patients and your willingness to support them through the test.
    • Provide patients with control over their appointment (e.g. they can ask to stop the test at any time.)
    • Provide time to explain the test and allow women to ask any questions, including that they have the right to request a female provider.
    • Reassure the patient that the consultation is private and confidential.

    Make the procedure as comfortable as possible

    • Offer self-collection as a more comfortable and acceptable screening option.
    • Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.
    • If clinician-collection is chosen some of the below points may assist.
      • Offer patients the opportunity to perform the test in a different position (e.g on their side rather than their back, letting them have their hands and arms free during the examination).
      • Consider use of a smaller speculum.
      • Some patients may prefer to insert their own speculum and it can be helpful to offer this option.
      • Providing instructions on calming and deep breathing techniques can also help the patient to relax.

    Supportive environment

    • Place relevant posters or pamphlets in your practice to indicate an awareness and willingness to discuss sexual assault and support patients to undertake cervical screening.
    • Encourage the patient to bring a friend or support person to the appointment.
    • Offer and/or advertise the availability of counsellors and provide contact details.

    Patient records

    If sexual assault is disclosed, flag this in medical records so healthcare providers are aware for future visits.

    Choice of cervical screening collection method

    • Offer the choice of either self-collection or clinician-collection screening options.
    • Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.

    Choice of cervical screening provider

    • Ensure female cervical screening providers are available if requested.
    • Refer patients to a cervical screening provider who is experienced in working with people who have experienced sexual assault.
    • If sexual assault is disclosed, provide additional support and referrals as required.
    Last updated:

    Help us improve health.gov.au

    If you would like a response please use the enquiries form instead.